[Comparison of transthoracic, transesophageal, and intracardiac echocardiography sensitivity for guiding transseptal puncture during radiofrequency ablation in the left atrium].

The paper contains comparison of sensitivity and rates of false negative results of transthoracic (TT), transesophageal (TE), and intracardiac (IC) echocardiography (echoCG) during transseptal puncture in the run of the procedure of radiofrequency ablation of atrial fibrillation. In the work fulfilled we analyzed results of 208 echocardiographical intraprocedural investigations conducted with the aim of visualization of interatrial septum (IAS) during transseptal puncture. TT, TE and IC echoCG were carried out in 32, 26, and 150 cases, respectively. Phenomenon of IAS stretching was visualized by TT echoCG in 2 (6%) cases (sensitivity 6.7%). At TE tenting phenomenon was verified in 20 patients (20%) (sensitivity 86.9%). Puncture of IAS was carried out under IC echoCG control in 127 patients. Puncture was made in the center of thin portion of IAS (in the region of fossa ovalis), in its upper and lower portions in 65, 28, and 15.7% of cases, respectively. Sensitivity of IC echoCG was 98.4%. Rate of false positive results reached 92.8, 13.04 and 1.5% for TT, TE and IC echoCG, respectively. At present IC echoCG is most sensitive and safe ultrasound technique for verification of optimal positioning of the system for conduct of transseptal puncture in the region of IAS in comparison with TT and TE echoCG.

[The experience of the use of intracardiac echocardiography during puncture of atrial septum].

We analyzed results of 175 intracardiac ultrasound studies (ICUS) in 113 men (mean age 54,6 +/- 11,0 years) and 62 women (mean age 49,7 +/- 8,9 years) with atrial fibrillation (n=146) and WPW syndrome (n=29). ICUS was used for guidance of catheters or electrodes from right to left atrium through atrial septum in 160 procedures of radiofrequency ablations for atrial fibrillation (n=146) or WPW syndrome (n=14). Complications of transseptal puncture developed in 4 patients (2,7%) with atrial fibrillation. There were no procedure related deaths. In all cases ICUS allowed to visualize interatrial septum and its thinnest part. Thus ICUS facilitates transseptal approach to the left atrium, provides lowering of risk of dangerous complications, and allows real time monitoring of possible intraprocedural complications.

[Transesophageal echocardiography in diagnosis of infectious endocarditis]. / Chrespishchevodnaia ékhokardiografiia v diagnostike infektsionnogo éndokardita.

Transthoracic and transesophagal echocardiography (TT EChG and TE EChG) were performed in 43 patients with infectious endocarditis (IE). Sensitivity and specificity of TE EChG in detection of vegetations were higher (92 and 75%, 81 and 50% for TE EChG and TT EChG, respectively). Vegetations and thromboembolism were unrelated. With TE EChG, morphologically verified perforations of valvular cusps were revealed 3 times more frequently than with TT EChG. Along with detection of vegetations and dysfunction of the prosthetic valve, an essential diagnostic marker of IE of the artificial valve is visualization of paraprosthetic fistulas in 2 of 5 patients. Indications for TT and TE EChG and techniques of their performance are described. TT EChG is used in screening for IE. TE EChG is conducted in complications of IE.

[Non-invasive mapping of cardiac electric potential of a specific quasi-epicardium]. / Neinvazivnoe kartirovanie élektricheskogo potentsiala serdtsa na sfericheskom kvaziépikarde.

A procedure was proposed for non-invasive mapping of the cardiac electrical potential or a spherical quasiepicardium from its synchronous multichannel measurement on the surface of the chest, i.e. routine electrocardiodraphic mapping. Mathematical simulation was used to demonstrate that the quasiepicardial potential can be calculated with the accuracy sufficient for clinical diagnosis by applying the multipole electric field resolution method with allowance made for three lowest resolution terms. Due to the fact that the spherical quasiepicardium is more approximate to the heart and more concentric as to its center than the chest surface, the maps of the quasiepicardial potential permit recognition of some features of the pattern of a cardiac electric process, which do not manifest themselves in the distribution of the potential on the body's surface. The examples showing that the assessment of a cardiac abnormality can be made more accurate by using this method are given in the paper.

[The use of echocardiography in examining patients with unstable stenocardia]. / Ispol'zovanie ékhokardiografii pri obsledovanii bol'nykh s nestabil'noi stenokardiei.

The report presents the results of EchoCG study in 81 patients with unstable stenocardia admitted in 6-24 hours from the onslaught pain. With the help of EchoCG the myocardial contractile function was defined and the segmental kinetics of left ventricular wall was registered with respect to four variants of unstable stenocardia courses: stenocardia occurred for the first time, progressive stenocardia, variational stenocardia and postmyocardial infarction stenocardia. During the EchoCG examination at the moment of anginal attack the significant increase in left ventricular end-diastolic volume and end-systolic volume and decrease of total ejection fraction were noted. Also, not infrequently the zones of dyskinesia are recorded indicative of ischemia of these segments, which commonly have transient character. With the progress of myocardial ischemia the abnormalities of left ventricular diastolic fraction appear which are determined with the help of Doppler-EchoCG. Thus, the use of EchoCG in diagnostics of patients with unstable stenocardia allows more reliably to define the degree of myocardial changes.

[The mechanisms of the development and diagnosis of myocardial infarct in septic endocarditis]. / Mekhanizmy razvitiia i diagnostika infarkta miokarda pri septicheskom éndokardite.

Based on the clinical, instrumental and biochemical findings, out of 104 patients with septic endocarditis 11 (10.6%) were diagnosed to have myocardial infarction. It was provoked by coronary artery embolism, the covering of the coronary artery ostium by vegetation from the aortal cusp, a decrease of perfusion pressure in atherosclerosis stenosed coronary arteries because of marked insufficiency of the aortal cusp. In more than half the cases, the clinical picture of myocardial infarction was atypical, painless. Echocardiographic demonstration of the vegetations near the coronary artery ostium permits forecasting the possibility of its covering with vegetation, the threat of the occurrence of acute coronary insufficiency, which may appear an additional indication for heart valve replacement.

[Prolonged cardioselective blockade of beta-1 adrenoreceptors in combination with increased diuresis as a method of choice in the treatment of hypertension]. / Prolongirovannaia kardioselektivnaia blokada beta-1-adrenoretseptorov v kombinatsii s usilennym diurezom kak metod vybora v lechenii gipertonicheskoi bolezni.

The clinical effects of Tenoric, a long-acting combined drug (atenolol and chlorthalidone in a tablet), were studied in 31 patients with Stages I and II hypertensive disease, by using echocardiography, daily automatic blood pressure monitoring, bicycle ergometry, measurements of plasma renin and aldosterone. The drug was found to be highly clinically effective in labile and sustained hypertension. When given once or twice a day, it makes it possible to reliably monitor blood pressure, improve hemodynamic parameters, as reflected by lower cardiac output and decreased peripheral vascular resistance, reduce the estimated mass of the left myocardium, alleviate a pressor response to exercise and enhance its tolerance, lower plasma renin levels. The side effects of the drug are minimal and include moderate bradycardia. Peripheral vasospasm and systemic weakness were observed in single cases. There were no atherogenic changes in lipid spectrum and disturbed glucose and uric acid metabolism during the drug therapy.

[Differential echocardiographic diagnosis of a giant left atrium and pericardial effusion]. / Differentsial'naia ékhokardiograficheskaia diagnostika gigantskogo levogo predserdiia i perikardial'nogo vypota.

With a sharp increase in the sizes of the left atrium its wall in the form of a fold can be seen behind the left ventricle. An echo-free space is recorded in such cases on echocardiograms. It can be interpreted as pericardial exudate. Proceeding from an analysis of the results of ultrasonic investigation of 5 patients the authors have proposed some criteria for differential diagnosis between the gigantic left atrium and pericardial effusion.

[Features of the course and evaluation of the efficacy of surgical treatment of adhesive pericarditis with constriction]. / Osobennosti techeniia i otsenki éffektivnosti operativnogo lecheniia adgezivnykh perikarditov s konstriktsiei.

Two groups of patients with constrictive pericarditis were identified on the basis of clinical and instrumental examination including echocardiography and computerized tomography of the heart: patients with complete obliteration of the pericardial sac and constriction, and those with exudative/adhesive pericarditis and constriction. Part of the patients were subjected to subtotal pericardectomy. An improvement of left-ventricular diastolic function and hemodynamic parameters was demonstrated 1 to 1.5 months after the operation. Postoperative echocardiography showed persistent disorders of interventricular septum movement and multilayer abnormal echoes in the left-ventricular posterior wall area.